Effectiveness of School- and Home-Based Mental Health Services in Improving Learning and Behavior in Children in Urban Schools

There are an estimated 4.5 to 6.3 million children with mental disorders in the United
States. Emotional and behavioral problems associated with childhood mental disorders have a
significant impact, with affected children at an increased risk of reduced quality of life
and school dropout. If left untreated, childhood mental disorders may continue into
adulthood, often impairing ability to function as an adult. It is believed that, compared to
clinic-based services, school- and home-based mental health services may lead to greater
improvements in children's learning and behavior at school and home. Especially important to
this type of approach is a collaborative effort among parents, teachers, and children to
encourage and maintain positive behaviors and academic performance both at home and in the
classroom. This study will evaluate the effectiveness of school- and home-based mental
health services and training modules in supporting learning and behavior in financially
disadvantaged children who live in urban areas.

This 3-year study will involve parent, child, and teacher participants. During Year 1,
teacher participants will attend a professional development series that will focus on
strategies that classroom teachers can use to help children with learning and behavior
problems at school. The series will involve weekly 30-minute sessions, which will be held
before and after school hours, for a total of 6 months. Teachers will fill out a brief
survey about the content and structure of sessions at the end of each session and will give
a monthly review on how they are applying their new strategies in the classroom setting.
Teachers will continue to attend booster sessions of up to 1 hour each month during Year 2.
Teachers will also participate in periodic case consultation meetings with parents and
mental health providers to further develop ways to improve student participants' learning
and behavior.

Child participants will either undergo the community mental health program associated with
their school or receive general clinic-based services. The school component of the mental
health program will consist of a classroom environment in which the teachers implement their
newly learned strategies. The teachers will aim to enhance the academic and behavioral
performance of the child participants. Parents of child participants in the community mental
health program will be invited to attend a series of parent/teacher meetings and home visits
where mental health service providers will discuss strategies that parents and teachers can
use to help improve their children's learning and behavior. Parents will fill out a brief
questionnaire at the end of each meeting and will give a monthly review of how they are
implementing their new strategies in the home setting. Parents will continue to communicate
with research staff regarding services provided throughout the study.

Assessments for all participants will occur five times over 3 years. Assessments for parent
participants will include questions about their child's behavior at school and home, their
child's use of mental health services, involvement in their child's schooling, and possible
stresses in life. Assessments for teachers will include questions about the behavior and
academic performances of the child participants, parent involvement with the children's
schooling, and stresses in their work environment. A research staff member will also conduct
a 2-hour classroom observation five times over 3 years. Individual child participants will
also be observed in the classroom by research staff for three 15-minute intervals five times
over the study period.

Inclusion Criteria:

- Student in kindergarten through 4th grade in a participating school

- Diagnosis of conduct disorder, oppositional defiant disorder, or attention deficit
hyperactivity disorder as confirmed by parent and/or teacher report

Exclusion Criteria:

- Severe developmental or medical disability